November 1, 2013

The Honorable Barack Obama President of the United States The White House 1600 Pennsylvania Avenue NW Washington, DC 20500

Dear President Obama:

We are writing to you as individuals who are or have been leaders in major U.S. health institutions, as well as medical education, ethics, and research, and who are deeply invested in maintaining the principles of ethics and professionalism in American medical practice . We believe that the practice of force-feeding hunger strikers at Guantánamo Bay severely breaches those principles and undermines medical care at the detention center. While a Department of Defense release claims that mass hunger strikes have largely ended at Guantánamo, individual detainees remain on hunger strikes and protocols issued by command continue to authorize force-feeding. We urge you to put the practice to a stop and repeal protocols that authorize it.

As international and domestic standards for physician response to hunger strikes emphasize, the essential role of physicians in such cases is to maintain their doctor-patient relationship with the detainee, meet the patient’s medical needs, and counsel the patient. Respect for the patient’s decision-making, which is the foundation of trust between doctor and patient, is essential. Moreover, taking this approach can contribute to reducing the tension between prisoners and administrators and – in some cases – aid in the resolution of the underlying dispute. Force-feeding is utterly incompatible with these professional values, which is why the World Medical Association and the American Medical Association condemn its use.

Force-feeding undermines appropriate medical care and ethical responsibilities because physicians act as agents of command, a fundamental violation of professionalism. Detainees’ choices are not respected. Worst of all, a command protocol calls for the use of five-point restraints – twice a day for up to two hours – for the purpose of force-feeding. We agree with the president of the American Medical Association, James Lazarus, who wrote in the British Medical Journal that “in the AMA’s view, the use of restraints to force-feed detainees is an inhumane and degrading intervention that falls within the prohibition of torture.”

It is sometimes claimed that force-feeding is necessary to save lives. But the experience of countries that eschew force-feeding, including the United Kingdom and Israel, is that following ethical standards and adhering to medical professionalism does not result in the deaths of prisoners. We urge you to bring in physicians not beholden to commanders who can establish a relationship of trust with detainees, provide care in accordance with our traditions of professionalism, and respect ethical requirements.

In your June speech on national security, you said in reference to force-feeding, “Is this who we are? Is that something our founders foresaw? Is that the America we want to leave our children?”

The Honorable Barack Obama November 1, 2013 Page 2

We would answer a firm “No.” This practice is inconsistent with American values and the medical values and professional responsibilities that are so central to the role physicians, including military physicians, play in our society, no matter who the patient is.

It is time for the Administration to reaffirm our values, respect the human rights of detainees, and restore the ability of doctors to adhere to their clinical and ethical responsibilities by ending the force-feeding of hunger strikers.

Sincerely yours,

Deborah Ascheim, MD – Associate Professor in Departments of Health Evidence and Policy and /Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; Chair of the Board of Directors, Physicians for Human Rights

Herbert L. Abrams, MD, FACR, FACC, FAAS – Philip H. Cook Professor and Chairman of Radiology Emeritus, ; Professor Emeritus of Radiology, Stanford University School of Medicine; Founding Vice-President, International Physicians for the Prevention of Nuclear War

Eli Adashi, MD, MS – Professor of Medical Science, Former Dean of Medicine and Biological Sciences, Warren Alpert School of Medicine, Brown University

Peter Agre, MD – University Professor and Director of Molecular Microbiology and Immunology at Johns Hopkins Bloomberg School of Public Health; Recipient of the 2003 Nobel Prize in Chemistry

Scott Allen, MD, FACP – Clinical Professor of Medicine and Associate Dean of Academic Affairs at University of California-Riverside; Former Medical Program Director, Rhode Island Department of Corrections

Neal Baer, MD – Executive Producer

Elizabeth Blackburn, PhD – Morris Herzstein Professor in Biology and Physiology in the Department of Biochemistry and Biophysics at University of California-San Francisco; Recipient of the 2009 Nobel Prize in Physiology or Medicine

Craig Blakely, PhD, MPH – Dean, University of Louisville School of Public Health and Information Sciences

Richard Carmona, MD, MPH, FACS – 17th Surgeon General of the United States

G. Thomas Chandler, MSc, PhD – Dean, Arnold School of Public Health at the University of South Carolina

Jane Clark, PhD – Professor and Dean, University of Maryland - College Park School of Public Health

Frank Davidoff, MD, MACP – Editor Emeritus Annals of Internal Medicine and Institute for Healthcare Improvement; former Interim CEO, Physicians for Human Rights

The Honorable Barack Obama November 1, 2013 Page 3

Felton Earls, MD – Professor of Social Medicine Emeritus at , Research Professor of Human Behavior and Development, Harvard School of Public Health; Member of Human Rights Committee at National Academy of Sciences

Ruth Faden, PhD, MPH – Philip Franklin Wagley Professor of Biomedical Ethics and founding Director of the Johns Hopkins Berman Institute of Bioethics

John Finnegan, Jr., PhD – Dean, University of Minnesota School of Public Health

Jeffrey S. Flier, MD – Dean of the Faculty of Medicine, Caroline Shields Walker Professor of Medicine, Harvard Medical School

Howard Frumkin, MD, DrPH – Dean, University of Washington School of Public Health

H. Jack Geiger, MD, M Sci Hyg – Arthur C. Logan Professor of Community Medicine Emeritus at City University of New York; Founding Member and Past President, Physicians for Human Rights

Lynn Goldman, MD, MS, MPH – Dean, The George Washington School of Public Health and Health Services

Roger Guillemin, MD, PhD – Distinguished Scientist at the Salk Institute (La Jolla, CA); Recipient of the 1977 Nobel Prize in Medicine or Physiology

Howard Hiatt, MD – Professor of Medicine, Harvard Medical School, and Former Dean, Harvard School of Public Health

Pascal James Imperato, MD, MPH, TM – Dean and Distinguished Service Professor, Downstate Medical Center School of Public Health at the State University of New York

Michael J. Klag, MD, MPH – Dean, Johns Hopkins Bloomberg School of Public Health

Richard Kurz, PhD – Professor and Dean, University of North Texas Health Science Center School of Public Health

Robert S. Lawrence, MD, MACP, FACPM – Center for a Livable Future Professor of Environmental Health Sciences, Health Policy and International Health, Johns Hopkins Bloomberg School of Public Health

Jay Maddock, PhD, FAAHB – Professor and Director, Office of Public Health Studies, University of Hawaii at Manoa

Robert Meenan, MD, MPH, MBA – Dean, University School of Public Health

Philip C. Nasca, PhD – Dean, University at Albany SUNY School of Public Health

David G. Nathan, MD – President Emeritus Dana-Farber Cancer Institute; Physician-in-Chief Emeritus Boston Children’s Hospital; Robert A Stranahan Distinguished Professor of Pediatrics Harvard Medical School The Honorable Barack Obama November 1, 2013 Page 4

Martin Philbert, PhD – Dean, University of Michigan School of Public Health

Paul Brandt-Rauf, DrPH, MD, ScD – Dean, University of Illinois at Chicago School of Public Health

Irwin Redlener, MD – Earth Institute, Professor of Policy, Management, and Pediatrics at Columbia University

Barbara Rimer, DrPH, MPH – Dean and Alumni Distinguished Professor, University of North Carolina at Chapel Hill, Gillings School of Public Health

Sir Richard Roberts – Chief Scientific Officer at New England Biolabs; Recipient of the 1993 Nobel Prize for Physiology or Medicine

Carleen Stoskopf, ScD – Director, Graduate School of Public Health, San Diego State University

Jack Szostak, PhD – Professor of Genetics, Harvard Medical School; Recipient of the 2009 Nobel Prize in Medicine or Physiology

Paul Volberding, MD – Director of University of California, San Francisco AIDS Research Institute and Director of Research for University of California, San Francisco Global Health Sciences

Torsten Wiesel, MD – President Emeritus, Vincent and Brook Astor Professor Emeritus at Rockefeller University; Recipient of the 1981 Nobel Prize in Physiology or Medicine

Stephen N. Xenakis, MD – Brigadier General (Ret), U.S. Army

*All signatories have signed in their personal capacities; institutional affiliations are noted for identification purposes only.

Please direct all correspondence regarding this letter to:

Deborah Ascheim, MD c/o Physicians for Human Rights 1700 Broadway, 17th Floor New York, NY 10019